The Adolescent Girls' Anaemia Control Programme : A decade of programming experience to break the inter-generational cycle of malnutrition in India

The journey from Pilot to Scale

Implications of Anaemia

Becomes anaemic during

pregnancy

Baby born with low iron stores and

haemoglobin level. Increased risk of

childhood stunted.

Uncorrected anaemia in infancy and childhood

Enters adolescence with low iron stores &

haemoglobin level

Adolescent enters reproductive cycle

with low iron stores & haemoglobin

level

Intergenerational Impact

Negative Consequences of

Anaemia

Impaired physical growth & cognitive

development

Poor reproductive outcomes

Reduced work productivity &

income earning capacity

20 % of Adolescents (10-19 years) : in world are from India

48% of Indian adolescents are GIRLS !!!

1 out of 2 Adolescent girls -

anaemic

• 56% anaemic*

• 20% moderate to severe anaemia

• 16 % begun child bearing

• Dietary iron intake <50% of

Recommended Dietary Allowance

(NNMB 2012)**

*DLHS 2 and NFHS 3Source : World Population Prospects : The 2012 Revision

Knowledge centered program cycle : from Innovation to Universalization

EVIDENCE

Using national and global research and

findings

INNOVATION

Pilot testing an innovation with

scale

EVALUATION

Documenting the effectiveness of an

innovation

REPLICATION

Expanding an effective

intervention

UNIVERSALIZATION

Scaling up and mainstreaming Knowledge

generation and

dissemination

VM Aguayo et. al. 2013

Global research seemed to indicate Weekly

schedule of Iron and Folic Acid Supplementation could be practical, safe and effective strategy in

reducing anaemia prevalence

UNICEF initiated a Pilot to control Adolescent Anaemia among girls

Starting: Year 2000 (20 districts in 5 states)

Platform: Govt. schools,Anganwadi centres

Target group

School-going adolescent girls (grade 6th to 12th)Out of School Adolescent Girls

Channel: Nodal teachers (responsible for providing interventions to students), field level anganwadi workers (for out of school girls)

Programme Elements

Three interventions

Every week One Iron Folic Acid tablet (100 mg elemental iron and 0.5 mg folic acid)

Biannual deworming (Albendazole 400 mg)

Monthly Nutrition Education

Strategy: Fixed day, Fixed site, fixed responsibility

UNICEF : technical and financial lead for programme design, capacity building, IEC, supply gap filling, monitoring and evaluation, documentation

Health and Family

Welfare

Women

and Child

Development

Human

Resource

Department

Convergence of Three Ministries

• UNICEF initiated a pilot in 20 districts of 5 states

• Expanded to 52 districts of 13 States* by end of 2005

• Covering 8.8 million adolescent girls

• Expanded to all districts of 13 states* by 2011

• Covering 27.6 million adolescent girls

• Government of India launched the Nation-wide ‘ WIFS’ Programme in 2012

• Targeting 108 million adolescent girls and boys both

2000 – 05 Innovation Phase

2006 – 11 Evaluation -

Consolidation Phase

2012 onwards Universalization Phase

Phase-wise Progress

* UNICEF supported

Aimed to document cost and effectiveness

Scaling up by the Government

Reduction in prevalence of overall anaemia (HB <120g/l) in adolescent girls after 1 year of implementation

8175

88

6573

78

40

53

80

54

39

54

AndhraPradesh

Gujarat MadhyaPradesh

Maharashtra UttarPradesh

Pooled

Baseline Endline

Over all anaemia : Statistically significant 24 %age point reduction (30.6% decrease)

Moderate to severe anaemia : Average 8.4%age point reduction (43.1 % decrease)

For both girls & boys

Launched in 2012

Program Coverage: From Pilot to Universalization (2000 to 2015) : A decade of programming experience

2000-2001 2002-2005 2006-2010 2011 2012-2015

20 districts/5 states

52 districts /13 states

State-wide/13 states (Govt. funds)

All States and UTs (Government funds)

Pilot Expansion Universalization

14.5 million

8.8 million

108million

27.6million

State-wide/13 states

Girls only Girls and boys both

INR 21 – 62 per adolescent girl per annum(supplies, training, communication, monitoring and assessment)

INDIA WIFS : The ten make-

or break elements

10 1 23

45

67

8

9

Techno-managerial unit at state level

Partnership with academic/training institutes to capacity building

Preventing supply stock outs

Emergency Response System for managing adverse effects

Sustained positive engagement with media

Branding andcelebrities

Basket of services

On fixed day

Reinventing strategies for

unreached

Convergence needs highest authority’s

leadership

Use of evidence and partner’

coalitions

Acknowledgements

Government of IndiaVictor M. AguayoKajali PaintalGayatri Singh Jee Hyun Rah Vani Sethi